Injury prevention

Playing Technique
#2

I am interested to know too.

I have been applying a very simple principle: if it starts to hurt, just stop. I am not talking about real pain, but about that point where the tension on my fretting hand fingers starts building up and I get that feeling that if I continue, it will hurt. I have been applying this and never got injured. Not sure if that’s the only reason.

When it comes to the picking hand, I never really did anything in particular. But I would apply the same principle.

It would be interesting the hear the opinion of someone who really knows the subject :grin:

#3

My brother is a physiotherapist and I had debilitating guitar induced RSI for a decade, so this is a topic that I’ve talked and thought about quite a bit.

At the most basic, problems with RSI come down to one thing:

You are causing more damage to your body per unit of time than it can recover from.

This means there are two things you can do to prevent injury

Damage reduction

  • Better technique
  • Less playing :frowning:
  • Reduce other activities that damage the same parts of the body (manual labor, weight training etc)

Increase recovery

  • Adequate sleep
  • Proper nutrition
  • Reduce stress in general (the body’s maintenance machinery is put on hold by the stress response)
  • Anti-inflammatory medication / cortisone injections

I had several cortisone injections and rounds of anti-inflammatory medication and it didn’t do anything. I did a literature review a while back and once it turns into a chronic problem you’re basically screwed, with no good treatment options.

To conclude, once you get pain that lasts for days: take it seriously and take a break. Let your body recover. It’s much better to lose a few days of practice than to get a chronic problem that prevents you from playing for an extended period of time.

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#4

John Petrucci’s Rock Discipline was my bible for the first several years of playing, and I still do the warmup routine he recommends in there.
Recently I’ve had some twinges in my picking arm and RSI-like symptoms in my hand/wrist. and I’ve pretty much done what the others are saying here - take a break. I was pushing my picking speed really hard when it started. It’s been a week now with no picking and the pain has pretty much gone away. Actually I’ve been developing a pretty good fretting-hand-only legato technique as a result, haha.

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#6

I do hand and arm exercises.

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#7

I am in the midst of some really terrifying injury-like feelings right now. I regularly play/practice 4hrs per day, been doing the same thing for years, though for the last year I have been working a shit day job where I am on the computer 7.5hrs a day. I have this warm feeling every now and again, in my right elbow, it never bothers me while I play, but I can sometimes just “feel” that it’s there, a difference. It has perplexed me for going on 3 weeks now, taken breaks 2 days off, 1 on, 3 days off, always feels a bit more pronounced 1-2 days after practice. It’s nothing I would take an aspirin for or anything, but, man, I am super concerned that it WILL begin to hurt, sometimes in the mornings I wake up and it’s a little achy, it’s scaring the hell out of me. Just a few days ago I started feeling it in my left elbow too. I have myself convinced that this is the end for me, that the last 15yrs of my life that was spent practicing hours and hours a day are all for nothing, it’s starting to effect my sleep, having nightnares, and have never been more depressed…dare I say, borderline suicidal. I am a very “all or nothing” person, and the ability to not be able to play, contribute, create music is more than I can handle. Have a Dr. appointment in 8 days, doing everything I can to rest, at home and work, but this thing has been going on for 3, maybe 4 weeks with my right arm, hope I am not already too late, it hasn’t turned into “pain” per se, but it just always feel tight, and if I really exert myself with certain motions doing chores around the house, I sometimes get this warm burn for a few seconds that reminds me that something isn’t right in there. Doing stretches, trying to drink more water, not sure if NSAIDS would do anything as there isn’t much focal pain. Any advice? Sorry, this may require it’s own thread

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#8

I think it might help you to read in the Terry Syrek thread about one poster’s experience with focal dystonia and how modifying his attitude to the instrument was essential to his recovery.

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#9

Hi there, I have unfortunately had a lot of experience dealing with injuries and pain issues related to playing.

Fortunately I’ve worked through them, more or less, and did a lot ton of research on the subject over the past ten years or so including working with different doctors, physical therapists, and also some study of the alexander technique.

Below is a combination of miscellaneous notes on the subject, compiled from other posts i’ve made in different forums as well as emails to students:

my left hand video for technique (not covered: body awareness/sitting position/full body technique)

anything tough/new get into it gradually - new gauge of strings, some new physically challenging technique (like new chords or fast lines with pinky stretching,) or lots of bending - don’t go all in, start with something like that in small doses
keep practice material varied, do not repeat the same things over and over again

never play for more than 25 minutes at once - play 25, break 5 and let your arms and hands truly rest, then play again.
the rest:

  • 5 minute true rest - nothing with the hands.Activities could be:
    • nothing/true rest
    • Solfege singing practice
    • Listening to inspiring music
    • Relaxing and focussing on the breathe
    • (do nothing with your hands!!! No typing, etc)

mindful of what material is more likely to cause pain…like stretching and fast playing. mix up your practice routine so that you don’t have consistent focus on the things that are causing physical pain

self massage/rolling techniques are quite nice - painful but in the process (if you’re doing it right) but do loosen you up. Look up ‘rolling’ or lacross ball rolling, for forearms or shoulders, neck

technique is #1. Most non-classical guitarists have no idea what they are doing when it comes to positioning, posture, etc.
I think there’s big potential for injury in jazz and rock guitar because so many jazz and rock and blues guitarists start out playing ‘easier’ music like rock and folk, music that you can play pretty well with ‘bad’ technique and sloppy posture, but then taking that same physical approach towards music with stretches, more challenging left hand fingerings, etc, seems to me to be a recipe for disaster. That was my experience at least, sloppy rock guitarist and didn’t have any problems when I was playing simpler music…

Beware of excess ‘tension’ - much easier said than done. Tension in your neck, shoulder, elbow or forearm can lead to an injury in your hand. Also note that it’s easy to get physically tense when we are mentally tense - frustrated at not progressing as fast as we’d like, nervous about a gig, etc.

Listen to warning signs. If something starts to feel a little funky and it lasts for more than a few days, don’t let it progress to something worse. Simplest thing - take a break.

Be mindful of how you use your hands in other activities, typing, sports etc. Intensity, frequency, etc.

Maintain a neutral wrist - not tensed to be straight, but avoid significant pronation, supination, or deviation.

The Alexander Technique perspective is that a huge component of injury prevention is maintaining good use of the head and spine, which on the surface isn’t that difference than the typical recommendation: “maintain good posture.”

In theory good posture is good, but one can also have misconceptions about what good posture is and actually be tensing and flexing different muscles to contort oneself into what he or she perceives as an ‘upright’ position. It’s something to look into. Bending your neck over to the look at the fretboard can cause lots of problems. It’s difficult to play guitar without turning your shoulder up and/or inward, but it’s worth it to try.

when it’s serious: see doctors and get different opinions. it is likely that you won’t get anything definitive from different people but get started on getting a medical perspective. PT and OT can at minimum give you a lot of things to consider

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Repetive Strain Injury from guitar practice
#10

I can’t stop thinking about what my aikido sensei told me once. He said that some chinese martial art styles use fingers a lot, and pracitioners of those styles usually have to do a lot of eyes exrercises. When I asked ‘why?’ he said that excessive use of fingertips makes eyesight problems. I can’t say that I was convinced that time, like - what the hell is connection between fingers and eyes??
And you know what? Looks like he was right after all ((

#11

After an intense technique session I’ll take 3 Advils (for a total of 600 mgs of ibuprofen) and also apply an icepack to any strained areas of my wrist or elbow. Ice can work wonders! I haven’t had an injury in the last 14 years at least.

I especially make sure to apply ice if the elbow of my picking hand is so strained after an intense practice session to the point where it’s difficult to completely extend my right arm without pain. The ice and Advil seem to have helped because there was a time around 20 years ago when I’d get so injured I couldn’t play for two weeks. Not only have I not had an injury in the last 14 years or more but my playing is the best its ever been now after almost 34 years of playing. I attribute a good deal of that to using better biomechanics in my technique now than I used to use.

As a general rule, injuries occur when a guitarist plays many more hours at high intensity levels than he is used to playing. For example, if you’re used to playing 4 hours a day, playing 5 hours one day shouldn’t hurt you, but if you’re used to playing one hour a day and then play 5 hours at high intensity one day, the likelihood of incurring an injury increases dramatically.

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#12

I’ve had to do this as well… but its more for my fretting hand… my wrist sometimes gets that warm, strained feeling, and I use ibuprofen and ice.

The hardest thing to do is just ‘stop’… and layoff guitar for a few days. But sometimes its a must. I had to do that a few months ago… and I had to really re-evaluate my form and where the tension was coming from.

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#13

I wouldn’t say that I’m in a similar postion in that I am suffering from an injury, but what I find at present is that with intense practice daily, my hands are fatigued and a little stiff- borderline sore the next day (but not painful). Its kind of like the feeling next day after running (lactic acid build up?). So I am now looking into how I can recover more effectively so that I can continue daily practice, using the following;
1 - force myself to do random practice - this stops me from repeating the movements for extended period. I practice a lick for 3 minutes, then a 30 to 60 second break where I shake my arms and hands out and massage hands (or completely rest), before repeating the same for a different random exercise/lick. After I have cycled 3 lots of 3, 36 minutes have gone (27 of that was deliberate and potentially intense picking practice) so a longer break is needed - I take 10-15 mins to get a drink and do ear training which makes the break more bearable. The whole thing can be repeated a few times, without too much issue. It wont in itself stop me from reaching that point of fatigue, but the breaks help me notice the early signs so that I can stop and come back to it later.

2 - Stay hydrated. I am a heavy tea drinker (I’m from UK) and like coffee as well. I’m trying to substitue it for water when practicing to stay as hydrated as possible during and after practice

3 - Soak hands and arms in warm water before and during the long breaks, it helps me stay loose.

4 - reduce inflamation after practice with stretches. As per the above post I might try an ice pack to see if it helps.

I have taken Ibuprofen before where I had definite inflamation, but I wouldn’t recommend daily use as it can reallly mess your stomach up. It also masks pain - there is a risk of playing through injury.

Please note that I have not been doing the above for long, so the jury is still out on how effective it will be, but thought I’d share. I’m glad to see that it touches on areas of the posts in this thread…

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#14

I don’t take it more than twice a week. It’s not after every practice session - just some of the extreme ones.

#15

Makes sense, I thought it was the case, but thought I’d point it out for the benefit of others. In all honesty, I probably do it more than I would like, but I take it for the aches and pains if life rather than guitar playing… i think I need to get in better shape!

Thats really great, you sound like an experienced player that has put in a ton of hrs over the years. I’d do well take your advice!

Have you ever used a compression glove/sleeve/strap? My day job is office based and I use a wrist strap that stops me from extending/flexing my wrist sometimes that aids recovery, but I havent tried an actual compression strap type thing.

#16

Thank you for the compliment. I started playing when I was 15 and I’m 49 now. I started out playing 3 hours a day for the first 7 years approximately. Then my practice got more erratic. I’d go two weeks without picking the guitar up, get pissed that my playing wasn’t up to my standards and play very hard for 10 hours or so until I was satisfied that I was back in top form. Often the next day I’d wake up with tendonitis and have to take a week or 10 days off for it to heal and so the cycle continued. But for the last 14 years I’ve been disciplined and haven’t had a single injury. It’s in the last 2 or 3 years that I’ve had the best progress of my life (except for the first 2 years of playing when anything you do makes you better).

You don’t necessarily get injured by playing a lot of hours a day. You get injured from playing much longer and/or much harder than you are used to playing! A guy who plays 3 hours a day probably won’t get injured from playing 4 hours one day but a guy who plays one hour a day might very well get injured from playing hard for 3 or 4 hours in one day? Does that make sense to you? You get hurt from doing far more than you have conditioned yourself to being able to do…

#17

Yes it does. I think the hardest bit is finding the right balance - If you push too hard you give yourself problems, but if you dont push at all you don’t see any progress!

#18

You guys might be interested in one of these. (Link below). The idea is to keep your finger muscles balanced by strengthening the muscles that open the fingers. The closing motion is used much more and likely over developed in comparison.

https://www.metoliusclimbing.com/grip_saver_plus.html

#19

That is really interesting - thanks!

#20

I woke up, and saw this in my youtube videos. A terrifying thought. I hope Rick recovers.

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#21

When I started to play, I started gradually and it wasn’t until year 3 that I was really playing several hours a day. I always played electric and didn’t even own an acoustic.

I met a couple friends who started playing around my 3rd year. They were really passionate about it, and right from their very first couple of months were playing 3+ hours a day. Both of them ended up with hand problems.

If I had to guess, they didn’t ease into it and because they were beginners, they didn’t have time to refine their technique and make it more economical. IOW, 3 hours of playing for them, would probably take the same amount of effort as me playing 8 hours a day.

Beginners should be looking for ways to make their technique more economical and they should ease into playing.

Additionally, a beginner would probably learn as much watching videos and reading instead of actual playing. So less time on the guitar, more time studying is probably a good idea.

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#22

I bought some of these years and never got around using them much.

Physiologically, the idea of “balancing” your muscles make no sense to me if applied to the forearms. The muscles for opening and closing the fingers are both inside the forearm. Structural imbalances within the forearm are impossible. It would be equivalent to claiming that training your support grip (e.g. holding on to a heavy barbell) would lead to imbalances unless you trained finger strength too.

I also don’t believe there is that much strength involved. Beginners are usually strong enough to fret chords, they’re just limited by endurance and soft finger tips. Finger speed is mostly control.

If you think that you have strong fingers from playing guitar, try rock climbing. The finger strength needed for the smaller grips is way beyond the fingers strength needed for guitar playing.

In the case of guitar playing if you’ve been playing for a while you don’t need any more strength. It’s all endurance. In strength training, it’s considered endurance if you can do more than 30 reps of a given exercise. And we’re not talking about slowing down but to the point where your limb won’t even move. Now imagine playing until the your left hand stops moving, that would be well over 30 reps.

Long strory short I believe that finger strength training tools for guitar are a gimmick since guitar is primarily an endurance exercise. There is also something known as the “interference effect” between strength and endurance, which means if you want to specialise in endurance, it’s better to avoid strength training.

Another aspect is that strength is the result of muscle size and neuromuscular adaptation. For guitar it mainly comes from neuromuscular adaption, and the thing with this sort of adpation is that highly specific to the motion you’re rehasing. This is why olympian weightlifters are usually much stronger than bodybuilders. They focus all their training on perfecting only 2 lifts by rehearsing the motions over and over, while bodybuilders want to achieve balance for all the muscles of the body. Similarly, for guitar playing, any training “tool” that doesn’t mimic the exact motions of guitar playing will be a waste of time. You’re best training tool is the guitar.

For warmups, stretching before physical activity has been debunked years ago. The whole point of warming up is to increase blood flow, stretching does the opposite.

I personally don’t do any warm up routine. Playing at moderate speed for a few minutes should be sufficient for injury prevention purposes.

Pain is usually a sign that muscle or joint damage has already occured, so it’s very important to avoid any movement that are causing pain, for at least enough time for you to heal. Connective tissue (e.g. “joint”) pains will heal much slower than muscle pain, because they have a lot less blood flow the the tissue. This is why the general advice of “complete rest for 1-2 weeks” is bad, you will heal faster is you keep playing, this will bring oxygen to the tissue and help it heal, the key here is play lightly and avoid the motion that you do know causes pain.

I am by no means an expert on posture or injury prevention for guitar playing, I do have though some knowledge when it comes to strength training, I have a science based approach, and am trying those principles to guitar. One thing that I’ve always hated from guitar teachers is that they have so many dogmas. I’ve been looking for a science based approach to learning and now I’ve finally found something with CtC. But in the case of muscle strength and endurance I do believe the science of of muscle strength and endurance is already out there and can be applied to guitar.

I also find it funny how common it is to hear players make analogies between guitar playing and weight lifting. It doesn’t make any sense at all when you question it.

To prevent shoulder, back, neck pains, etc, posture is important but whole body strenght training helps a lot too.

For example I’ve had neck pains in the right side for a long time due to my profession. I am a dentist and working with a neutral posture never really possible. Kind of like when you look down a left to see your fretting hand on the guitar. Except I don’t have the luxury to take as many breaks when I’m at work.

What has really helped relieve this pain completely was training my upper trap muscles with weigths.

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